Background

It is estimated that a doctor performs 160,000 to 300,000 interviews during a lifetime career, making the medical interview the most commonly performed procedure in clinical medicine.¹ Multiple evidence-based studies have shown that the interpersonal and communication skills of doctors correlate with improved health outcomes, improved quality of health care provided, and enhanced patient satisfaction. Improved communication enriches the overall health of patients by increasing the efficiency and cost-effectiveness of health-care delivery and enhances the satisfaction of both patients and practitioners. More than a decade ago, Kaplan, Greenfield, and Ware² presented data from four clinical trials conducted in varied practice settings among chronically ill patients. The trials demonstrated improved patient health from physiologic, functional, and subjective standpoints related to specific aspects of physician-patient communication.² A cross-sectional observational study of 7204 adults revealed that physicians’ comprehensive knowledge of patients and patients’ trust in their physician were the variables most strongly associated with therapy compliance, and trust was the variable most strongly associated with patients’ satisfaction with their physician.³

In addition, poor communication and lack of caring or collaboration in health-care delivery is often associated with the development of mistrust by the patient and the decision to litigate with filing of malpractice claims.⁴ As early as 1997, the Journal of the American Medical Association⁵ published a study of 124 primary care physician, general surgeon, and orthopedic surgeon offices in Oregon and Canada assessing the differences in communication behaviors of “no-claims” and “claims” physicians. No difference was noted between the physicians in the surgical practices, but among the primary care physicians, “no-claims” primary care physicians used more statements of orientation (educating patients on what to expect), laughed and used more humor, and tended to use more facilitation (soliciting patients’ opinions, verifying understanding, encouraging patient feedback). “No-claims” physicians spent more time in routine visits than “claims” primary care physicians, and the length of the visit was an independent predictor of the claims status.⁵ The first study revealing a clear relationship between communication and malpractice in surgeons was reported in 2002. It was found that a surgeon’s tone of voice in routine visits is associated with malpractice claims history.⁶

To address the importance of training in effective communication, in 1999 the Accreditation Council for Graduate Medical Education (ACGME)⁷ endorsed six general competencies that postgraduate residents should demonstrate, one of which was interpersonal skills and communication. Starting in 2004, all national and international medical graduates applying for postgraduate training in the United States were required to demonstrate competence in clinical, interpersonal, and communication skills on the U.S. Medical Licensing Examination (USMLE) clinical skills examination.⁸

Communication With Patients/Family

At the beginning of a patient encounter, the clinician should always introduce himself/herself to the patient/family. The truth is that patients/family want to know, and be reminded, who the members of the medical team are. Numerous doctors, nurses, and technicians may come in contact with a critically ill patient every day, and it is unrealistic to expect that patients/families remember names and faces during this extremely stressful experience.

When a patient’s/family’s first language is something other than English, a “nonfamily” interpreter should be used whenever possible. An interpreter allows for better clarity and simplicity in exchange of medical information and permits families to focus on key elements of medical decision making that require their consent or involvement.

When establishing a relationship with a patient/family, it is always important to elucidate the primary medical concerns and reason for seeking medical attention. Although this seems obvious, the “chief complaint” often does not correlate with the ultimate reason for admission. A further adjunct to this is to ask patients/families what they hope to “get” out of the hospital visit. One may find the medical team goals to be very different from the patient/family goals.

During a patient’s hospitalization, the family is often the first to notice changes in patient status, from new complaints of pain, to changes in level of consciousness, or technical differences like a persistently elevated heart rate. It is important to be receptive to new or ongoing concerns from patients/families because their comments may herald important changes in the patient’s condition.

Families pay close attention to medical rounds and desire to, and should, be included. It has been shown that parent involvement on medical rounds is perceived to improve communication and lead to better care and increased satisfaction for both families and members of the medical team.⁹ In addition, if a parent/guardian is unable to be present during medical rounds, he/she should be contacted frequently during hospitalization by a member of the medical team to discuss the patient’s condition.